Supplements can be a hedge against osteoporosis

Adequate calcium and vitamin D important in maintaining bone health

Osteoporosis or low bone density is a national affliction, one likely to become more problematic as the population ages. More than 44 million Americans currently suffer from the disease. The majority are women. It’s estimated that one in two women and one in four men over the age of 50 will break a bone due to osteoporosis.

Much is known about the causes of osteoporosis and how to prevent it, but occasionally, the information becomes confusing. For example, the Institute of Medicine (IOM) has recommended women older than 50 supplement their diets with calcium and vitamin D, but the U.S. Preventive Services Task Force (USPSTF), a health advisory group, recently said there’s no evidence that supplementation makes a measurable difference.

We asked Drs. Deborah Kado and Heather Hofflich, specialists in treating osteoporosis in the UC San Diego Health System, to help clarify the situation.

Q: Where do you stand on the issue of vitamin D and calcium supplements? The IOM says women older than 50 should consume 1,200 milligrams of calcium daily to promote bone health, but the USPSTF has said low supplemental doses of calcium or vitamin D are ineffective in helping prevent fractures and the evidence for higher doses is unclear.

A Kado: The USPSTF is correct in concluding that the available evidence does not support calcium or vitamin D supplementation as effective for preventing fractures. But it is clear that having adequate calcium in the diet and sufficient vitamin D are important in maintaining bone health. My recommendation (in line with current FDA regulations) is that older women and men should take about 1,200 milligrams of calcium daily. The average American consumes about 500 to 600 milligrams, so I usually advise that additional calcium supplementation of about 600 milligrams is ideal.

With regard to vitamin D, having sufficient levels is important for optimizing the amount of calcium in the bone. This vitamin helps ensure adequate calcium absorption from the gut and also favors keeping a good balance of calcium in the bone. I generally recommend 800 to 1,000 IU daily of vitamin D3.

Q: What about findings that suggest high calcium intake may increase the risk of heart disease in women?

A Kado: Even before recent publications suggesting that women who take calcium supplementation greater than 800 milligrams daily are at increased risk of heart attacks and mortality, there were some physicians who voiced belief that taking calcium could lead to calcium buildup in the arteries. However, this assumption is simply a hypothesis with no sound evidence to support it. My personal view is that patients should be aware of their daily calcium intake, try to achieve at least 600 milligrams and generally not take more than 800 milligrams daily in supplements.

Q: How much of a problem is vitamin D deficiency, particular in sunny places like San Diego?

A Hofflich: Studies have shown that even places like San Diego still have a high level of vitamin D deficiency. In 2008, when vitamin D became a “hot topic,” I did order levels on many of my patients and found a high level of vitamin D deficiency/insufficiency. One issue is that people wear sunscreen, which reduces vitamin D absorption because they are not receiving adequate sun exposure. This is likely a major reason for some vitamin D deficiency. However, sunscreen is important because it prevents skin cancer. That’s why patients should supplement with vitamin D, if needed.